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FOR OFFICE USE: -------------------------------------------------------- ------------------------�---------- APPLICATION FOR SANITATION PERMIT Permit No. ------------e------------------------------------------- (Complete in Duplicate) Data Issued y --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOSADDRESS AND LOCATION---------- ------ / r� C�--------------------------------------------------------------•---------------• ------------- Owner's Name-------------------------------- tom' f!` ��fr�•q -1c:- Phone. kif/ ..--------•-- Address----------------------------------------------4-, �.-1- --------0,0f- --••-------------------- ------------------------------••------•-•----- Contractor's Name----------------------------•-c _P � ------------------------------------------------------------- Phone-..--••-•-----------_----------- Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-r_. Number of bedrooms _3? Number of baths -------- Lot size ---,-- I ----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--- -------,--------I No New Construction: Yes Z No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_W,,Ct1Q_Distance fr2m foundation_-./.c---------.Material.-_ r/ No. of compartments-------�-----------Size_.._.�_.Y-. --- --�.-.Liquid depth__..-.---5� ----------Capac+ty.__..- �'_ .. Disposal Field: Distance from nearest well...j0_)A65Distance from foundation---.lQ-_f---._p....Distance to nearest lot line----__-.4-._.-.. Number of lines___.--------:------- Length of each line---lG C,, -5.,0 Width of french.------ ._..__r-----__-___ Type of filter material2_----Depth of filter material--_779-_----;_.-Total length----------1 m__0-------------------- Seepage23 a J : Distance to nearest well.----L-y O-4.�Distance from�ndation__.._ZZ-_--.--..Distance tp nearest lot lin��.c.�----._ Number of pits__------I------___Lining material_.�,�---_------Size: Diameter-,5-r{2X- _-Depth-----.._�___-_---------------- N Cesspool: r istance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------- E] PO Size: Diameter-------------------------------------Depth------------------------- ---------------------- Liquid Capacity------.....------------._..gals . Privy: 'f Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- El .--- ____-----------------_-_----.❑ Distance to nearest lot line------------------------------------------------------------------------------ --•------------------••-•----------------------------.-------- Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------•-------•----------------------------- -------------------------_--- ----•---•-••---•---------. ------------------------------------ ---------•------• --------•-----------.----- ---•---------------•-----------------------------------------------------------------•---------------•---------------------- I hereby certify that I have prepared this application and that the work will be done in-accordance with San Joaquin County ordinances, State laws, and rules and rulationself the San Joaquin Local Health District. Ir(Signed)-x------ ----------------- -------------------------------- (Owner and/or Contractor) Sy:-------------------•---------------------------------- ------------------------ ------------------------------ ---------------(Title)----------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D PARTM T USE'ONLY , APPLICATION ACCEPTED BY ---------------------------•---------------- DATE-- 0,/ --0---•--------•-------------- REVIEWED BY ---------------- ----------------- DATE BUILDINGPERMIT ISSUED------------------------ --- ----------------------------------------------------------•------------ DATE--------------------------- -- Alterations and/or recommendations:----t: +s��_-_ ....- ---__-_ ti--..- !�L� _,--_ � _,r __ _----_ �'r_± �p/ vl- --*,-L ----•------------------------- - ---•-----------••-----------••----------•-••---•-•-------------•---------------------- ---•-•--•-•------------ ------------------------------ ---------------- r � FINALINSPECTION BY:----------------------- ------------------ --------------------- Date---------------------------------- ------•--------:------------- -------------- 3/ ------------- 3l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 0.60 F.P.00.9M 6.67